Basic Information
| Provider Information | |||||||||
| NPI: | 1588003875 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAUTERIVE | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | RUTH | ||||||||
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| Credential: | MSW, CSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 CARLSON PKWY N | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | PLYMOUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554474466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8554826237 | ||||||||
| FaxNumber: | 8557632748 | ||||||||
| Practice Location | |||||||||
| Address1: | 8550 UNITED PLAZA BLVD | ||||||||
| Address2: | SUITE 702 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708092256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8554826237 | ||||||||
| FaxNumber: | 8557632748 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2013 | ||||||||
| LastUpdateDate: | 06/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 12267 | LA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.